Intervention Review

Palliative chemotherapy for advanced or metastatic colorectal cancer

  1. Lesley Best1,*,
  2. Peter Simmonds1,
  3. Chris Baughan2,
  4. Roger Buchanan3,
  5. Carol Davis4,
  6. Ian Fentiman5,
  7. Steve George6,
  8. Margot Gosney7,
  9. John Northover8,
  10. Chris Williams9,
  11. Collaboration Colorectal Meta-analysis10

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 24 JAN 2000

Assessed as up-to-date: 15 NOV 1999

DOI: 10.1002/14651858.CD001545


How to Cite

Best L, Simmonds P, Baughan C, Buchanan R, Davis C, Fentiman I, George S, Gosney M, Northover J, Williams C, Collaboration Colorectal Meta-analysis. Palliative chemotherapy for advanced or metastatic colorectal cancer. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD001545. DOI: 10.1002/14651858.CD001545.

Author Information

  1. 1

    University of Southampton, Cancer Research Campaign, CRC Wessex Medical Oncology Unit, Southampton, UK

  2. 2

    Southampton University Hospitals NHS Trust, Royal South Hants Hospital, Cancer Care Directorate, Southampton, Hampshire, UK

  3. 3

    Royal South Hants Hospital, Department of Radiotherapy, Southampton, UK

  4. 4

    Moorgreen Hospital, Countess Mountbatten House, Southhampton, UK

  5. 5

    Thomas Guy House, Guy's Hospital, Academic Oncology, London, UK

  6. 6

    University of Southampton, Health Care Research Unit, Southampton, UK

  7. 7

    University of Reading, Institute of Health Sciences, Building 22,, Reading, UK

  8. 8

    St Mark's Hospital, Colorectal Cancer Unit, Harrow, Middlesex, UK

  9. 9

    Royal United Hospital, Cochrane Gynaecological Cancer Review Group, Bath, UK

  10. 10

    c/o Henri Mondor Hospital, Creteil, France

*Lesley Best, Cancer Research Campaign, CRC Wessex Medical Oncology Unit, University of Southampton, Level F (824), Centre Block, Southampton General Hospital, Southampton, SO 16 6 YD, UK. peter.simmonds@ed.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2000

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Despite the increasing use of palliative chemotherapy for advanced colorectal cancer, there remains uncertainty as to the true effectiveness of this intervention. This review was therefore undertaken to assess the available evidence for the benefit of palliative chemotherapy in this disease.

Objectives

To determine the benefits and harms of palliative chemotherapy in patients with locally advanced or metastatic colorectal cancer. A secondary objective was to investigate outcomes for younger and elderly patients.

Search methods

Trials were identified by computerised and hand searches of the literature, scanning references and contacting investigators.

Selection criteria

All randomised controlled trials of palliative chemotherapy compared with supportive care alone in patients with advanced or metastatic colorectal cancer.

Both randomised and non-randomised studies were considered when searching for data on quality of life, resource use and cost effectiveness of palliative chemotherapy.

Data collection and analysis

Investigators from all eligible studies were asked to supply individual patient data. Meta-analysis was performed using both published data and individual patient data. Studies were grouped according to whether chemotherapy was administered regionally or systemically.

Main results

13 randomised controlled trials representing a total of 1365 randomised patients met the inclusion criteria. Meta-analysis of a subset of trials that provided individual patient data demonstrated that palliative chemotherapy was associated with a 35% (95% CI 24% to 44%) reduction in the risk of death. This translates into an absolute improvement in survival of 16% at both 6 months and 12 months and an improvement in median survival of 3.7 months. The overall quality of evidence relating to treatment toxicity, symptom control and quality of life was poor.

Authors' conclusions

Chemotherapy is effective in prolonging time to disease progression and survival in patients with advanced colorectal cancer. The survival benefit may be underestimated by this meta-analysis, as a proportion of patients in the control arms of some trials received chemotherapy. No age related differences were found in the effectiveness of chemotherapy, but elderly patients were under represented in trials. Treatment toxicity and impact upon quality of life and symptom control have been inadequately assessed in the majority of trials and further research is needed to clarify the palliative benefit of chemotherapy.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Chemotherapy improves the survival of people with advanced colorectal cancer, but the adverse effects and impact on quality of life are not yet known.

Colorectal (bowel) cancer is common worldwide, but can often be treated effectively with surgery. In some people, however, the cancer returns and sometimes also spread to other parts of the body. When this happens, chemotherapy (anti-cancer drugs) can be used to try to slow the progression of the cancer. However, chemotherapy also have adverse effects.
The review of trials found that chemotherapy improves survival of people with advanced colorectal cancer. However, the effects of treatment upon quality of life are not yet clear and need more study.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

緩和性化學治療(Palliative chemotherapy)對於末期大腸癌或移轉性大腸癌的治療

儘管有越來越多末期大腸癌患者接受緩和性化學治療,但是對於這樣治療方法的實際效用仍存在著許多不確定性,因此本研究希望能針對有效證據進行評估,以瞭解緩和性化學治療對這類疾病的效益

目標

本研究的主要目的在於評估緩和性化學治療對患有局部性末期大腸癌或是移轉性大腸癌患者的效益及可能危害,本研究的次要目的則是想要瞭解緩和性化學療法對於較年輕或較年長患者的治療成效。

搜尋策略

藉由電子和手動方式針對文獻、檢索參考文獻進行檢索,並與試驗者聯繫以確認納入本研究的試驗

選擇標準

所有針對末期或轉移性大腸癌患者進行緩和性化學治療和支持性照護治療比較的隨機性對照試驗都會被納入本研究中。但是一旦檢索有關於緩和性療法生活品質、資源利用、成本效益等治療成果時,不論是隨機性試驗或是非隨機性試驗的結果都會被考量

資料收集與分析

所有適當納入本研究的試驗研究者都會尋求提供個別患者的治療數據。利用已公開的資訊及個別患者數據以進行後設分析,研究係根據局部性或系統性施行化學治療來進行分組

主要結論

在13個包含有1365名隨機選取受試者的試驗符合本研究的納入標準,針對一個提供有個別患者資料的的子集進行後設分析可以發現,接受緩和性化學治療可以降低35%引發死亡的風險(95%的信心區間介於24%至44%之間),將這個數值轉換為6個月和12個月存活率的絕對改善結果都為16%,並可以增加中存活率3.7個月,與治療毒性、症狀控制和生活品質有關的證據整體品質都較為貧乏

作者結論

化學治療對於延長疾病惡化發作時間和提升末期大腸癌患者的存活率都十分有幫助,化學治療對存活率的幫助在本研究的後設分析中可能有被低估的情形,因為有一部份在某些試驗中為對照組的患者有接受化學治療,化學治療對不同年齡患者的影響並沒有差異,但是試驗中的受試者通常為較年長的患者。治療毒性和對生活品質及症狀控制的影響在主要試驗中都沒有受到適當的評估,因此需要進行更多的試驗來釐清緩和性化學治療的效益

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

化學治療可以提升末期大腸癌患者的存活率,但是有關於接受化學治療可能引發的不良事件和對生活品質的影響目前仍缺乏完整的了解,大腸癌在世界各國都十分普遍,但是通常可以經由手術而獲得有效的治療,然而對於有些患者來說,癌症會再復發,有時甚至會散佈至身體其他部位,當這樣的情形發生時,可以使用化學治療(抗癌症藥物)來嘗試著減緩癌症惡化的速度,但是,化學治療也存在有引發不良事件的危險,針對相關試驗進行審閱可以發現,化學治療可以改善患有末期大腸癌患者的存活率,只是進行化學治療對於患者生活品質的影響仍無法明確知曉,並且需要更多的試驗來解決這樣的疑惑